Is Nicotine Addictive? It Depends on Whose Criteria You Use

By PHILIP J. HILTS,

Published: August 2, 1994

WASHINGTON, Aug. 1—
When heavily dependent users of cocaine are asked to compare the urge to take cocaine with the urge to smoke cigarettes, about 45 percent say the urge to smoke is as strong or stronger than that for cocaine.

Among heroin addicts, about 38 percent rank the urge to smoke as equal to or stronger than the urge to take heroin. Among those addicted to alcohol, about 50 percent say the urge to smoke is at least as strong as the urge to drink.

In April, seven chief executives of tobacco companies testified before a Congressional subcommittee that nicotine was not addictive. Experts in addiction, while disagreeing with that assessment, say that the definition of addiction is evolving, and that they can see how such a statement might be made. Hearings on Smoking

This week, the Food and Drug Administration is holding hearings to consider whether cigarettes fit in the array of addictive drugs and whether the Government should regulate them.

The standard definition of addiction comes from the American Psychiatric Association and the World Health Organization, which list nine criteria for determining addiction. The two groups, which prefer the term drug dependence, base their definition on research done since the 1960's, which has determined that multiple traits must be considered in determining whether a substance is addictive.

Thus although cigarettes do not offer as intense an effect as drugs like heroin and cocaine, they rank higher in a number of other factors. They not only create dependence among users but also elicit a high degree of tolerance, the need for more and more of a drug to satisfy a craving. When all the factors are added up, the consensus view among scientists is that nicotine is strongly addictive.

In smoking, it is not the nicotine or addiction that is most harmful, but other toxic chemicals produced by burning tobacco, which cause most of the 400,000 deaths each year that are attributed to smoking.

Dr. Lynn T. Kozlowski, an addiction expert at Pennsylvania State University, said addiction could generally be defined as "the repeated use of a psychoactive drug which is difficult to stop." He added that there might be many explanations for why it was hard to stop, including withdrawal that was too disturbing, or a high that was too enticing.

A diagnosis of mild dependence on a psychoactive drug is determined by meeting three of the nine criteria. Five items show moderate dependence and seven items indicate a strong dependence. (Not all nine items apply to each drug. For example, time and effort spent acquiring a drug are a significant feature of heroin addiction, but have no meaning in nicotine addiction.) 9 Addiction Criteria

These are the criteria:

*Taking the drug more often or in larger amounts than intended.

*Unsuccessful attempts to quit; persistent desire, craving.

*Excessive time spent in drug seeking.

*Feeling intoxicated at inappropriate times, or feeling withdrawal symptoms from a drug at such times.

*Giving up other things for it.

*Continued use, despite knowledge of harm to oneself and others.

*Marked tolerance in which the amount needed to satisfy increases at first before leveling off.

*Characteristic withdrawal symptoms for particular drugs.

*Taking the drug to relieve or avoid withdrawal.

Before applying a test of the nine criteria, the expert first determines if the symptoms have persisted for at least a month or have occurred repeatedly over a longer period of time.

Asked about the tobacco executives' testimony on addiction, Dr. Kozlowski said: "In a way, I can see how they could say that. It has to do with a mistaken image of what addiction is, and I have many well-educated, intelligent people say something like that to me. People often think of a person taking one injection of heroin and becoming hopelessly addicted for the rest of their lives. That is wrong."

In addition, he said, when people tend to think of the high that heroin produces, one that is about as intense as cocaine and alcohol, they cannot believe cigarettes are in the same category. And they are not. Even though in large doses nicotine can cause a strong high and hallucinations, the doses used in cigarettes produce only a very mild high.

But researchers now know, says Dr. Jack Henningfield, chief of clinical pharmacology at the Addiction Research Center of the Government's National Institute on Drug Abuse, that many qualities are related to a drug's addictiveness, and the level of intoxication it produces may be one of the least important.

If one merely asks how much pleasure the drugs produce, as researchers used to do and tobacco companies still do, then heroin or cocaine and nicotine do not seem to be in the same category. Dr. Kozlowski said, "It's not that cigarettes are without pleasure, but the pleasure is not in the same ball park with heroin."

But now, he said, there are more questions to ask. "If the question is, How hard is it to stop? then nicotine is a very impressive drug," he said. "Its urges are very similar to heroin."

Among the properties of a psychoactive drug -- how much craving it can cause, how severe is the withdrawal, how intense a high it brings -- each addicting drug has its own profile.